动脉化疗栓塞治疗恶性梗阻性黄疸

目的：探讨胆道支架置放后动脉化疗栓塞治疗恶性梗阻性黄疸(MOJ)的并发症和疗效，研究影响黄疸复发时间和患者生存期的预后因素。方法：51例MOJ患者放置胆道支架后接受动脉化疗栓塞术(TACE)，观察手术并发症，血清胆红素下降程度，随访黄疸复发时间和患者生存期。分析性别，年龄，肿瘤类型，术前血清胆红素浓度、碱性磷酸酶、谷丙转氨酶、白蛋白、血红蛋白浓度，梗阻时间，梗阻水平10个因素对黄疸复发时间和患者生存期的影响。结果：51例共计放置支架64枚，行TACE术86次，技术成功率为100％。1例于术后1个月死亡，在治疗过程中，4例出现肝脓肿。4例失访，51例生存期为1～34个月，平均9．0个月，中位值8．0个月。22例黄疸复发，复发率43．2％，黄疸复发时间2～14个月，平均11．0个月，中位值9．0个月。单因素(P=0．010)和多因素(P=0．010)分析均显示术前血清总胆红素浓度是影响患者生存期的重要因素。单因素分析显示对黄疸复发有显著影响的因素为肿瘤类型(P=0．035)。结论：MOJ患者放置胆道支架后进行TACE术，可以延缓黄疸复发，延长患者生存期。术前血清总胆红素浓度高的患者生存期较短；肝细胞肝癌患者的黄疸复发时间较非肝细胞肿瘤患者明显延长，黄疸复发率亦低于后者。

Transcatheter Arterial Chemoembolization in Treatment of Malignant Obstructive Jaundice

Objective: To evaluate the efficiency and complications of transcatheter arterial chemoembolization(TACE) in treating malignant obstructive jaundice(MOJ) after biliary stent deployment,and to study factors influence jaundice recurrence time and survival. Methods: After biliary stent deployed, fifty- one patients with MOJ received TACE. Complications, droppment of serum total bilirubin level, jaundice recurrence time and survival were observed. Ten variables including gender, age, tumor classification, preoperative serum total bilirubin level, alanine aminotransferase, alkaline phosphatase, albumin, hemoglobin, duration of obstruction, obstructive level were studied as prognostic factors for jaundice recurrence time and survival. Results: A total of 64 biliary stents placement and 86 times of TACE were performed in fifty - one patients. Technical success was 100% , one patient died within the first month after procedure, four patients developed liver abcess. Overall mean survival was 9.0 months (median: 8. Omonths, range; 1-34months). Jaundice recurred in 22 patients(49. 0%) , overall mean jaundice recurrence time was 11. 0 months (median: 9. 0 months, range:2-14 months ). Both univariate(P = 0. 010) and muiltivariate a-nalysis(P = 0. 01) showed preoperative serum total bilirubin level was the variable influenced survival. Univariate analysis indicated tumor classification was the variable associated with jaundice recurrence time (P= 0. 035). Conclusion: The survival and jaundice recurrence time can be extended by means of TACE after biliary stent deployment. According to this study, the higher the preoperative serum total bilirubin level, the shorter the patients' survival. Jaundice recurrence time of patients with hepato-cellular carcinoma(HCC) was longer than patients with non- HCC tumor, and jaundice recurrence rate of patients with HCC was lower than patients with non- HCC tumor.